The devastating consequences of cyberbullying during adolescence justify the relevance of obtaining empirical evidence on the factors that may cause participation in its distinct roles. The goal of this study was to analyze the predictive capacity of aggressiveness (physical aggression, verbal aggression, anger, and hostility) and emotional intelligence (attention, understanding, and emotional regulation) with respect to being a victim, aggressor or victim-aggressor of cyberbullying during adolescence. The Screening for Peer Bullying, the Aggressiveness Questionnaire and the Trait Meta-Mood Scale-24 were administered to a sample of 1102 Spanish secondary education students, aged 12 to 18. In general, results revealed a higher probability of being a victim, aggressor or victim-aggressor as physical aggressiveness and anger increased. On the other hand, results revealed a low probability of being a victim, aggressor or victim-aggressor as emotional understanding and emotional regulation increased. These findings highlight the importance of considering said variables when creating prevention programs to stop or reduce the social and educational issue of cyberbullying during adolescence.
Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still mix up CKD with chronic kidney insufficiency or failure, For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus, health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is “solved” by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated aging and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal COVID-19 and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality which is 10- o 100-fold higher than similar age peers, and life expectancy is shortened by around 40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth global cause of death by 2040 and the second cause of death in Spain before the end of the century, a time when 1 in 4 Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded CIBER network research structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients (AAKP) and the European Kidney Health Alliance (EKHA). Leading Spanish kidney researchers grouped in the kidney collaborative research network REDINREN have now applied for the RICORS call of collaborative research in Spain with the support of the Spanish Society of Nephrology, ALCER and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true.
Background and aim In December 2019, a coronavirus 2019 (COVID-19) outbreak, caused by SARS-CoV-2, took place in Wuhan and was declared a global pandemic in March 2020 by the World Health Organization (WHO). It is a prominently respiratory infection, with potential cardiological, hematological, gastrointestinal and renal complications. Acute kidney injury (AKI) is found in 0.5-25% of hospitalized COVID-19 patients and constitutes a negative prognostic factor. Renal damage mechanisms are not completely clear. We report the clinical evolution of hospitalized COVID-19 patients who presented with AKI requiring attention from the Nephrology team in a tertiary hospital in Madrid, Spain. Methods This is an observational prospective study including all COVID-19 cases that required hospitalization and Nephrology management from March 6 th to May 12 th . We collected clinical and analytical data of baseline characteristics, COVID-19 and AKI evolutions. Results We analyzed 41 patients with a mean age of 66.8 years (SD 2.1), 90.2% males, and with a history of chronic kidney disease (CKD) in 36.6%. 56.1% of patients presented with sever pneumonia or acute respiratory distress syndrome (ARDS), and 31.7% required intensive care. AKI etiology was prerenal in 61%, acute tubular necrosis in the context of sepsis in 24.4%, glomerular in 7.3% and tubular toxicity in 7.3% of the cases. We reported proteinuria in 88.9% and hematuria in 79.4% of patients. 48.8% of patients required renal replacement therapy (RRT). Median length of stay was 12 days (interquartilic range 9-23) and 22% of the population died. Patients who developed AKI during hospital stay presented with higher C-reactive protein, Lactate dehydrogenase-LDH and D-dimer values, more severe pulmonary damage, more frequent intensive care unit-ICU admission, treatment with lopinavir/ritonavir and biological drugs and RRT requirement. Conclusions Hypovolemia and dehydration are a frequent cause of AKI among COVID-19 patients. Those who develop AKI during hospitalization display worse prognostic factors in terms of pulmonary damage, renal damage, and analytical findings. We believe that monitorization of renal markers as well as individualized fluid management can play a key role in AKI prevention.
Antecedentes y objetivo: En diciembre de 2019 surgió en Wuhan, China, la COVID-19 causada por SARS-CoV-2, declarada pandemia global por la OMS en marzo de 2020. Es una infección respiratoria con complicaciones a nivel cardiaco, hematológico, digestivo, neurológico y renal. El fracaso renal agudo (FRA) en pacientes hospitalizados por COVID-19 se presenta en el 0,5-25% y es un factor de mal pronóstico. Los mecanismos de afectación renal no están completamente aclarados. Presentamos la evolución clínica de pacientes ingresados por COVID-19 con FRA que requirieron atención por nefrología en un hospital terciario de la comunidad de Madrid, España. Métodos: Éste es un estudio observacional prospectivo de todos los casos que ingresaron por COVID-19 entre el 6 de marzo y el 12 de mayo de 2020 y requirieron atención por Nefrología. Se recogieron datos clínicos y analíticos de características basales, evolución de la COVID-19 y del FRA. Resultados: Se analizaron 41 pacientes con edad media de 66,8 años (DE 2,1), el 90,2% varones, y con enfermedad renal crónica previa en el 36,6%. El 56,1% presentaron neumonía grave o síndrome de distrés respiratorio agudo y el 31,7% requirió ingreso en UCI. El FRA fue de etiología prerrenal en el 61%, necrosis tubular aguda en contexto de sepsis en el 24,4%, glomerular en el 7,3% y por toxicidad tubular en el 7,3%. Se registró proteinuria en el 88,9% y hematuria en el 79,4%. El 48,8% de los pacientes requirió terapia de sustitución renal (TSR). La mediana de estancia fue de 12 días (RIC 9-23), y el 22% fallecieron-Los pacientes que desarrollaron FRA durante el ingreso presentaron valores más altos de proteína C-reactiva, LDH o dímero D, una afectación pulmonar más grave, más necesidad de ingreso en UCI, más tratamiento con lopinavir/ritonavir y fármacos biológicos y mayor necesidad de TSR. Conclusiones: La hipovolemia y deshidratación son una causa frecuente de FRA en pacientes COVID-19. Aquellos que desarrollan FRA intrahospitalario presentan un perfil de peor pronóstico respiratorio, analítico y renal. Creemos que la monitorización de marcadores renales, así como el manejo individualizado de la volemia pueden ser determinantes para prevenir el FRA.
Background Thrombotic microangiopathy (TMA) is a complication of malignant hypertension (mHTN) attributed to the high levels of blood pressure (BP). However, no studies have investigated in patients with mHTN of different etiologies whether the presence of TMA is associated with specific causes of mHTN. Methods We investigate the presence of TMA (microangiopathic hemolytic anemia and thrombocytopenia) in a large and well characterized cohort of 199 patients with mHTN of different etiologies (primary HTN 44%, glomerular diseases 16.6%, primary atypical hemolytic uremic syndrome (aHUS) 13.1%, renovascular HTN 9.5%, drug-related HTN 7%, systemic diseases 5.5%, endocrine diseases 4.5%). Outcomes of the study were kidney recovery and kidney failure. Results Patients with TMA (40 cases, 20.1%) were younger, had a lower proportion of males, lower BP levels and worse kidney function at presentation. Their underlying diseases were primary aHUS (60%), drug-related mHTN (15%), glomerular diseases (all of them IgA nephropathy) (10%), systemic diseases (10%) and primary HTN (5%). The presence of TMA was 92.3% in primary aHUS, 42.9% in drug-related HTN, 36.4% in systemic diseases, 12.1% in glomerular diseases and 2.3% in primary HTN. No patient with renovascular HTN or mHTN caused by endocrine diseases developed TMA, despite BP levels as severe as patients with TMA. A higher proportion of TMA patients developed kidney failure as compared to patients without TMA (56.4% versus 38.9%, respectively). Conclusions The presence of TMA in patients with mHTN should guide the diagnosis towards primary aHUS, drug-related mHTN, some systemic diseases and IgA nephropathy, while it is exceptional in other causes of mHTN.
Presentamos un caso de infección prótesis articular a los pocos meses de su implantación.Mujer de 37 años con antecedentes de luxación congénita de caderas, enfermedad de Crohn desde los 17 años con afectación ileocecal que cursaba con brotes frecuentes y obesidad. A los 31 años fue sometida a colectomía subtotal y a anastomosis ileorrectal. Posteriormente presentó insuficiencia suprarrenal secundaria que trataba con hidrocortisona 30 mg al día. En julio del 2004 le fue insertada una prótesis total de cadera derecha (Zimmer ® ) por dolor incapacitante. La intervención duró 190 minutos y recibió cefazolina 2 g en dosis única como profilaxis quirúrgica. En el postoperatorio hubo hemorragia local importante. Durante los 4 días posteriores presentó diarrea líquida sin productos patológicos. Tres meses después acudió por fiebre elevada (39,5 ºC), escalofríos, dolor en cadera derecha y supuración purulenta en la proximidad de la a través de la cicatriz. En la analítica destacaba 25.800 leucocitos/mm 3 (82% segmentados, 8 % cayados) hemoglobina de 10,3 mg/dl con VCM de 71 fl y 851.000 plaquetas/mm 3 e hipoalbuminemia (2,1 g/dl), dos hemocultivos fueron negativos. La radiografía mostraba aumento de partes blandas y aire en la proximidad de la prótesis ( Fig. 1). La paciente fue intervenida de urgencia comprobando la existencia de una fístula desde la piel a la región cercana a la prótesis donde se situaba una colección de material purulento y esfacelos que fue drenada. En el cultivo del absceso se aislaron Escherichia coli, Proteus mirabillis y Enterococcus faecium. Se inició tratamiento parenteral con vancomicina 1 g/12 horas e imipenem 500 mg/6 horas y curas en el quirófano. El quinto día se realizó una TAC abdominal que evidenció varios trayectos fistulosos que se originaban en el ileon de escasos cm de longitud pero sin demostrarse conexión con el área cercana a la pró-tesis. Mediante una laparotomía se objetivó un trayecto fistuloso desde un asa de ileon hasta la proximidad de la cadera derecha. Se resecaron 20 cm de intestino delgado afecto y se practicó una ileostomía. En el examen anatomopatológico se encontraron signos de actividad de enfermedad de Crohn y se confirmó la existencia de un fragmento de tracto fistuloso. La paciente fue dada de alta con tratamiento oral levofloxacino 500 mg/24 horas y cefuroxima 500 mg/12 horas de modo indefinido posponiéndose la retirada de la prótesis.La infección de una prótesis de cadera debida a fístulas de origen digestivo es una complicación muy infrecuente (1-3). Suelen aparecer en pacientes de edad avanzada y en el contexto de una enfermedad neoplásica colorrectal (3,4). La radioterapia, quimioterapia y el tratamiento con glucocorticoides pueden incrementar el riesgo de padecer esta complicación (3,5). Aunque la mayoría de los casos de fístulas entre el tracto digestivo y la articulación de la cadera se originan en el intestino grueso (1,5), hay casos cuyo origen es el intestino delgado (6), como en nuestro caso. Hay casos de enfermedad de Crohn que han desarrollado una f...
ResumenLas infecciones respiratorias, en general, son infecciones benignas autolimitadas, pero en ocasiones pueden producir cuadros graves y ser una causa importante de mortalidad y morbilidad, especialmente en los grupos de población más vulnerables. La gripe aparece anualmente de forma epidémica, pudiendo ocasionar pandemias cada varios años, como las producidas por los tipos H1N1 o H3N2. La clínica fundamental es la sintomatología respiratoria asociada a fiebre, pudiendo presentar complicaciones como la neumonía. Para la confirmación diagnóstica se recomienda la obtención de exudado nasofaríngeo y la realización de RT-PCR, pudiéndose obtener resultados también para otros virus. El tratamiento en general es sintomático, reservándose para los casos más graves el tratamiento con inhibidores de la neuraminidasa. La mejor medida preventiva es la vacunación anual a la población de riesgo. Otros virus con especial relevancia son los coronavirus por sus posibles implicaciones pronósticas y en la edad infantil debe tenerse en cuenta el virus sincitial respiratorio y los parainfluenza. Abstract Flu virus and respiratory virus infectionsIn general, respiratory infections are benign and self-limiting, but occasionally they can cause severe symptoms and become a major cause of mortality and morbidity, especially in the more vulnerable population groups. Flu epidemics occur annually, and there can be pandemics every few years, such as those caused by types H1N1 or H3N2. The main clinical manifestations are respiratory symptoms associated with fever, and complications such as pneumonia can arise. Nasopharyngeal swab and RT-PCR should be performed to confirm the diagnosis, which can yield results for other viruses as well. Treatment is generally symptomatic, reserving neuraminidase inhibitors for the more serious cases. The best preventive measure is annual vaccination of the population at risk. The coronavirus is also particularly relevant, due to its potential prognostic implications, and the respiratory syncytial virus and parainfluenza virus should be borne in mind in children.
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